We carried out an announced comprehensive inspection on 6 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the service on 22 March 2018 and found the service was not providing safe and well-led care in accordance with regulations. We asked the provider to make improvements regarding providing care and treatment in a safe way to patients and maintaining effective systems and processes to ensure good governance in accordance with the fundamental standards of care. There was no evidence of significant events being formally cascaded. The service had not taken action in response to historic cold chain breaches. The service did not have processes in place to ensure that the expiry dates of all equipment were being monitored. We checked these areas as part of this comprehensive inspection and found these concerns had been resolved.

The provider supplies private general practitioner and occupational health services.

The lead doctor is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We reviewed 25 CQC patient comment cards, all of which were positive about the service provided. The comment cards stated that staff were caring, the quality of care provided was excellent and that appointments were easily accessible.

Our key findings were:

• At this inspection, we saw concerns about breaches of the vaccine cold chain and equipment checks had been addressed and that the actions submitted in the service’s action plan following the inspection in March 2018, had been completed.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role. They knew how to recognise the signs of abuse and how to report concerns.
• Service leaders had established policies and procedures to ensure safety; leaders had assured themselves that all policies and activities were operating as intended.
• The service had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved.
• The service stocked medicines. Emergency equipment and medicines were available as described in recognised guidance. There was a documented system for recording and monitoring checks of emergency medicines and equipment.
• The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Services were provided to meet the needs of patients.
• Patient feedback for the services offered was consistently positive.
• We found evidence of quality improvement measures including clinical audits and there was evidence of action taken to change practice.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 22 March 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The provider supplies private general practitioner and occupational health services.

Dr Malcolm Cunard is the registered manager though the provider has submitted an application to change registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We reviewed 18 CQC patient comment cards, all of which were positive about the service provided. The comment cards stated that staff were caring, the quality of care provided was excellent and that appointments were easily accessible.

Our key findings were:

• Systems for monitoring the temperature of vaccines had historically not been effective. We found that the temperatures of both vaccine fridges had been below the recommended temperature range on numerous occasions (when the required range for vaccines is 2 – 8 degrees Celsius). No action had been taken in response at the time, although an action plan was submitted to address this concern after our inspection and additional evidence of the action taken in response to the incident was provided.
• We two items of expired medical equipment on the premises.
• There was a system in place for acting on significant events; however, learning was not being regularly discussed in meetings.
• Risks were well managed.
• There were arrangements in place to protect children and vulnerable adults from abuse.
• Staff had received essential training and adequate recruitment and monitoring information was held for staff.
• Care and treatment was provided in accordance with current guidelines.
• Patient feedback was positive regarding access, the quality of care and the attitude of all staff.
• The practice responded to patient complaints in line with their policy.
• The service had a vision and strategy and staff spoke of an open and supportive culture.
• There were clear governance structures and leadership roles within the organisation. However systems and processes for monitoring certain areas within the areas were not operating consistently; particularly in respect of the monitoring of equipment expiry dates and vaccine cold chain monitoring.

There were areas where the provider must make improvements (please see the Requirement Notices section at the end of the report for details):

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The service is based on the fourth floor of an office block and is accessed via a lift. The clinic was found to be visibly clean and well appointed. There were a number of consultation and treatment rooms, that enabled private and confidential consultations.

The service was accessed by appointment only, with fifteen minute appointment times. Physiotherapy and osteopathy appointment times were in half hour time slots. People that we spoke to said that this was enough time to discuss health issues and that they did not feel rushed.

The provider also had service level agreements with local companies and provided GP services or corporate services to those companies. People that we spoke to said that they had used the service on a number of occasions when falling ill at work and felt that it was an invaluable service as they did not lose working time and did not have to wait until returning home to see their NHS GP. Most people said that the service did not replace their NHS GP but supplemented it.

Everyone that we spoke to said that the staff were professional and helpful. No one had difficulty in finding staff to answer their questions and felt confident and in control of their health issues. Two people that we spoke to commented on the fact that they rarely saw the same medical professional twice but noticed that the physiotherapists were always the same people.